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Can Type 2 Diabetes Be Corrected with Bariatric Surgery

Can Type 2 Diabetes Be Corrected with Bariatric Surgery

Robert Velasquez

The prevalence of type 2 diabetes and obesity has increasingly grown in tandem worldwide.

 

Figure 1 - Shows the world prevalence of diabetes among adults
Figure 1 – Shows the world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. [1]
Figure 2 - Prevalence of Obesity at the Global Level
Figure 2 – Prevalence of Obesity at the Global Level, According to Sociodemographic Index (SDI). Shown is the age-specific prevalence of obesity at the global level and according to SDI quintile in 2015 (Panel A) and age-standardized prevalence trends at the global level and according to SDI quintile from 1980 through 2015 among children (Panel B) and adults (Panel C). [2]

As of today, the most effective treatment for severe obesity that can achieve long term weight loss is bariatric surgery.3 Particularly for those who have tried other ways to lose weight, such as dieting and exercising. Given the high association between these 2 pathologies (obesity and diabetes), the concept of ‘diabesity’ has been utilized to describe patients who are severely obese and diabetic at the same time.4 “The term diabesity is the unification of the words ‘diabetes’, referring to type 2, and ‘obesity’. It is a wonderful word because it is at once able to convey that they are truly one and the same disease. It is incredibly descriptive and evocative in the same way as the word ‘fugly’”, said Dr. Jason Fung, MD, a nephrologist and a world-leading expert on intermittent fasting and LCHF, especially for treating people with type 2 diabetes5 Of all the patients who undergo bariatric surgery, roughly 30% correspond to diabetes patients.

Type 2 diabetes mellitus (T2D) is associated with serious health consequences. The development of T2D has a strong association with obesity, sedentary lifestyle, genetic factors and other associations of diabetes.6 Faced with this problem, bariatric surgery has evolved as the treatment that produces a greater decrease in body weight long-term. Moreover, it is postulated that bariatric surgery currently may have a beneficial effect in improving pharmaceutical treatment and even promoting diabetes remission in obese patients.7

The surgical technique that offers the most benefit has been Roux-en-Y gastric bypass, which is why it’s the technique of choice of many obese and diabetic patients.

Figure 3 - Shows clinical factors associated with remission of obesity-related comorbidities after bariatric s
Figure 3 – Shows clinical factors associated with remission of obesity-related comorbidities after bariatric surgery [8]

A meta-analysis reported that gastric bypass presented a remission of diabetes type 2 of close to 60 % of cases, while a gastric band has allowed remissions of 29% of cases in the first year.

Figure 4 - Shows a study with a total of 61 patients with obesity and type 2 diabetes
Figure 4 – Shows a study with a total of 61 patients with obesity and type 2 diabetes. They were randomly assigned to receive either a year of intensive lifestyle weight loss therapy, a gastric band procedure, or a gastric bypass procedure. At the end of 3 years, none of the people who received intensive lifestyle therapy had achieved remission of their diabetes, 29% of those in the gastric band group achieved remission, and 40% of the gastric bypass patients achieved remission. [9]

“What we found is that the secret for the cure of diabetes after gastric bypass lies in the intestine. The key message is that after gastric bypass the intestine becomes the most important tissue for glucose use and this decreases blood sugar levels,” said Dr. Nicholas Stylopoulos, principal investigator at the Division of Endocrinology at Children’s Hospital Boston and Boston Medical School, in an interview with Healthline. 10

A diminution of glycemic levels, basal insulinemia, and glycosylated hemoglobin has also been observed. Thus, many patients can lower the use of oral hypoglycemic sulfonamides to fight diabetes.

A group of metabolic intestinal hormones, called incretins, play a central role in the remission of diabetes type II (along with weight loss and postoperative dieting). Incretins stimulate the secretion of postprandial insulin and are associated to the physiological mechanisms produced as a consequence of gastric bypass procedures that regulate or improve glycemic levels.

The Role of Bariatric Surgery

Weight loss procedures have permitted an important reduction of body weight in the long run, unlike other types of medical treatment. There are different surgical techniques at play: 11

  1. Restrictive
  2. Malabsorptive
  3. Mixed

The first gastric surgery that reported an improved control of diabetes took place in 1955, but it wasn’t until 30 years later that the procedure was considered clinically important. In the 1980s, it was observed that gastric bypass surgery is associated to improved glycemic 12 and insulinemic levels of around 77% – 97% during oral glucose tolerance tests. Today, bariatric surgery is recommended for patients who’s reiterated treatment plans have previously failed, present a BMI between 35 – 40 (or a BMI greater than 40, regardless of the presence of a chronic disease13), and have a medically relevant pathology whose prognosis is affected by obesity, such as arterial hypertension, diabetes, dyslipidemia, sleep apnea, or osteoarticular conditions. 14 The Roux-en-Y gastric bypass improves not only weight, but also ameliorates insulin resistance and improves glycemic levels.  

Surgical candidates should be rigorously evaluated by a medical team in order to ensure postoperative compliance and proper progression.

On the other hand, patients for whom bariatric surgery is contraindicated are those that suffer from:

  • Cardiac insufficiency
  • Severe respiratory insufficiency
  • Psychiatric disorders, such as psychosis
  • Inflammatory intestinal diseases
  • Hepatic insufficiency
  • Pancreatic insufficiency
  • Drugs or alcohol abuse problems
  • Malabsorption syndrome

 Complications of Bariatric Surgery

Although the rate of complications is relatively low (major complications occur in less than 10% of cases), they can cause significant disability. 15 Surgeries whose outcome adversely affected the patient have provoked claims of mal praxis, which are particularly problematic for bariatric surgery centers. For these reasons, performing surgeons should be well prepared and possess the exceptional technical skills required to handle complications when they occur.

Physiological reserves are significantly reduced in obese patients (and by extension, patients who seek bariatric surgery). As a result of their excessive mass, their bodies do not express possible complications clearly. For example, in people with normal BMI, peritonitis symptoms include tachycardia, fever, abdominal pain, and a high WBC reading from a CBC (complete blood count) as a consequence of sepsis. However, obese patients may just show tachycardia (lacking fever and abdominal pain) despite possible sepsis. Of all likely manifestations of intra-abdominal sepsis, a BPM reading of more than 120 is the most reliable finding in obese patients. “Any sustained heart rate reaching 120 beats per minute should be a red flag to check for a potential leak,” according to James A. Madura II, MD, director of the bariatric surgery program at the Mayo Clinic in Scottsdale, Arizona. 16 For this reason, when post-op bariatric surgery patients present any signs of tachycardia, the medical professionals in charge should assume that an intraabdominal abscess or an anastomotic leak may exist.17 Imaging studies for the purpose of confirming such a suspicion are difficult to observe and tend to be less reliable due to the size of obese patients.

Like any surgery, bariatric procedures carry a certain degree of risk for possible postoperative complications, especially the first 2 months after surgery. Common complications that have been observed during this time are embolisms, infection of the surgical wound, incisional hernias, and fistulas. “During the first few weeks after surgery, pulmonary embolism and a gastric leak from the anastomosis lead the list of life-threatening complications,” Dr. Madura said. 18  A gastric bypass, specifically, can cause complications, such as dehiscence of the anastomosis, intestinal obstruction, dumping syndrome, calcium deficiency, anemia, and vomiting. 19

On the other hand, possible complications after a vertical sleeve gastrectomy are minor when compared to a Roux-en-Y. However, they can present secondary vomiting (from overeating), intestinal stenosis, ulcers, intestinal obstruction, and pouch dilation. 20

Figure 5 - Shows the percent of those who undergo bariatric surgery experience complications
Figure 5 – Shows the percent of those who undergo bariatric surgery experience complications, mostly minor on 147 studies. Of these, 89 contributed to the weight loss analysis, 134 contributed to the mortality analysis, and 128 contributed to the complications analysis. [21]

After 2 months, a different set of complications can begin to appear. These include nutritional, hepatobiliary, and dermatological symptoms. Bariatric surgery can produce nutritional alterations as a result of anatomical and physiological changes to the digestive system. As a consequence, this procedure will produce a change in the quantity and quality of the diet, which in turn triggers the development of vitamin and mineral deficiencies. 22 In general, it’s very difficult for patients to consume over 1,000 calories a day after the first 2 months post-surgery, which doesn’t cover the daily requirements of vitamins and minerals.23 

Post-Op: Physiological Changes 

Various studies have detailed the intestinal hormonal changes that take place, especially that of incretins. These are vital to the homeostasis of glucose and effects on satiety. Among them we can highlight glucagon-like peptide-1 (GLP-1) and gastro-inhibitory peptide (GIP), both of which have demonstrated improvement of insulin secretion in diabetes type II patients. 24 GIP is secreted by the K cells of the proximal small intestine, whereas GLP-1 is secreted by L cells of the distal portion of the small intestine. 25

According to a study by Marianne Gosch C. and Pamela Rojas M., called ‘Can Type 2 Diabetes Be Corrected Via Bariatric Surgery?’, they state “In obese and diabetic patients, it is postulated that a chronic adaptation of pancreatic beta cells leads to a greater secretion of insulin, which presents a degree of impairment of the same to respond against sharp nutritional changes, such as the type of fasting required by post-operative patients. This explains the hypoglycemic episodes reported in many cases.” 26

Weight loss procedures, such as liposuction, have not demonstrated a relationship with an increase of incretin production. Rather, it is gastric bypass surgery itself that is responsible for the elevated secretion of GLP-1.  27

One hypothesis suggests that higher production of incretins is triggered by exposure of the small intestine to nutrients. After an ileal interposition surgery in rats, they presented a persistent increase of GLP-1 in plasma, as well as a heightened expression of mRNA for proglucagon in the ileum.28

Another hypothesis is called the ‘foregut’ hypothesis, which proposes excluding the proximal jejunum and the duodenum in the hopes it will inhibit a signal that promotes insulin resistance. This inhibition-by-exclusion is what happens after a gastric bypass procedure; it results in improvement of the body’s sensitivity to insulin, normalized glycemia levels during fasting, and better results from an oral glucose tolerance test (OGTT). 29

In a study of rats published in the Annals of Surgery (November, 2006), a group of scientists attempted to demonstrate the differences between a duodenal-jejunal bypass (DJB) and a Roux-en-Y procedure with regards to their effects on the interaction of the small intestine with nutrients, and how this interaction triggers a cascade of insulin regulation mechanisms.30 The rats that underwent a Roux-en-Y presented a better response to OGTT than the DJB group, although they were both helpful in controlling glycemia. Researchers concluded that anti-incretins produced in the proximal intestine can contribute to diabetes type II phenotype, while the exclusion of this portion would actually reduce the effects of diabetes. If there are more anti-incretins than incretins, it can result in hypoinsulinemia and an eventual shortage of pancreatic beta cells. Hence, this study successfully showed that the incretin system can be balanced out at the expense of the proximal segment of the small intestine by way of excluding it, which would explain the resolution of diabetes type II post-DJB. 30

Different studies have described the improvement of insulin resistance in post-operatory patients who underwent metabolic surgery to achieve weight loss. 31 Given that adiposity is a determinant of insulin sensitivity, it was verified that weight loss indeed improves insulin tolerance.32

Weight reduction also produces a diminution of proinflammatory cytokine markers, such as C reactive protein (CRP) and IL-6, as well as improving adiponectin levels (assuming significant weight loss)33.  Higher adiponectin levels mean better sensitivity to insulin.34 

We should also highlight the importance of diabetes type II evolution, since the normalization of the effect of incretins can persist for a whole year after surgery. Insulin secretion in diabetes patients can be very variable, depending on factors such as age, family history, current illness duration, and level of insulin resistance. For obese patients over the age of 40 who are diabetic, the resolution of their condition is rare, since it appears that the pathogenesis of hyperglycemia in morbid obesity compared to moderate obesity is different. 35

In a study led by Hall, it is suggested that the evolution of diabetes of 10 years or more, with bad glycemic control, would present poor remission rates. Predicting factors for successful remission are weight loss of at least 30% in 6 months post-op and a short duration of diabetes pre-op. 36 However, it has been observed that diabetes patients who underwent metabolic surgery and showed improvement of their glycemic levels have also presented a recurrence of diabetes. It is thought that regaining weight after bariatric surgery can be the main cause of this recurrence. This has been reported to be the case 2 or 3 years after surgery. Regaining weight can be favored by the loss of control of healthy food intake and with it the return of inappropriate dieting behaviors, or the consumption of foods that have a high glycemic index.

Nowadays, bariatric surgery represents an effective line of treatment against morbid obesity in conjunction with remission of diabetes type II. As a consequence, remission rates can be as high as 80% 37when the improvement of glycemia is concomitant with significant weight loss. The procedure most associated with remission of ‘diabesity’ is the Roux-en-Y gastric bypass technique. 38 There is still much left to investigate about the physiological changes that are produced post-op, since there are still discrepancies present in some studies. Furthermore, current research reveals that remission of diabetes 5 years after the operation decreases notably, for it is already being reported that diabetes type II can reoccur in up to 43% of cases. 39

“Gastric surgery isn’t for everyone, but this evidence suggests that, once you have diabetes and are severely obese, you should strongly consider it, even though it doesn’t seem to be a cure for most patients,” said David E. Arterburn, MD, MPH, a general internist and principal investigator of the largest community-based study of long-term diabetes outcomes after bariatric surgery at Group Health Research Institute. 40

References:

  1. Shaw JE, et al. Global estimates of the prevalence of diabetes for 2010 and 2030 (Diabetes Res Clin Pract. 2010) https://www.ncbi.nlm.nih.gov/pubmed/19896746
  2. Ashkan Afshin, M.D., et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years (The New England Journal of Medicine,2017) https://www.nejm.org/doi/full/10.1056/NEJMoa1614362?query=featured_home#author_affiliations
  3. Nestor De La Cruz-Muñoz, M.D., et al. Effectiveness of Bariatric Surgery in Reducing Weight and Body Mass Index Among Hispanic Adolescents (Obes Surg. 2013) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538108/
  4. Youssef M.K. Farag, Mahmoud R. Gaballa. Diabesity: an overview of a rising epidemic (Nephrology Dialysis Transplantation, 2011) https://doi.org/10.1093/ndt/gfq576
  5. Jason Fung, MD. Diabesity: Why Diabetes and Obesity Stem From the Same Problem (Diet Doctor, 2016) https://www.dietdoctor.com/diabesity-diabetes-obesity-stem-problem
  6. Richard E. Pratley, MD. The Early Treatment of Type 2 Diabetes (The American Journal of Medicine, 2013) https://doi.org/10.1016/j.amjmed.2013.06.007
  7. Chrysi Koliaki, et al. The role of bariatric surgery to treat diabetes: current challenges and perspectives (BMC Endocr Disord. 2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553790/
  8. Ida J. Hatoum, et al. Clinical Factors Associated With Remission of Obesity-Related Comorbidities After Bariatric Surgery (JAMA Surg. 2016) https://jamanetwork.com/journals/jamasurgery/fullarticle/2456119
  9. Courcoulas AP, et al. Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment (JAMA Surg. 2015) https://jamanetwork.com/journals/jamasurgery/fullarticle/2362353
  10. David Heitz. How Does Gastric Bypass Surgery Cure Type 2 Diabetes?  (Healthline) https://www.healthline.com/health-news/aging-how-gastric-bypass-eliminates-type-2-diabetes-072913#1
  11. Andrew Collier. Bariatric surgery and diabetes (Indian J Endocrinol Metab. 2012) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603033/
  12. Chrysi Koliaki, et al. The role of bariatric surgery to treat diabetes: current challenges and perspectives (BMC Endocr Disord. 2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553790/
  13. Who is a Candidate for Bariatric Surgery? (ASMBS) https://asmbs.org/patients/who-is-a-candidate-for-bariatric-surgery
  14. Jonathan Q. Purnell, MD, David R. Flum, MD, MPH . Bariatric Surgery and Diabetes. Who Should Be Offered the Option of Remission? (JAMA. 2009) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220451/
  15. Nancy J. O. Birkmeyer, PhD, et al. Hospital Complication Rates With Bariatric Surgery in Michigan (JAMA. 2010) https://jamanetwork.com/journals/jama/fullarticle/186297
  16. Charlotte Huff. Red flags for bariatric surgery complications (ACP Hospitalist, 2013) https://acphospitalist.org/archives/2013/12/bariatric.htm
  17. Ann R Coll, Complications of Bariatric Surgery: Presentation and Emergency Management – Review, (Surg Engl, May 2009) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749388/
  18. Charlotte Huff. Red flags for bariatric surgery complications (ACP Hospitalist, 2013) https://acphospitalist.org/archives/2013/12/bariatric.htm
  19. Radwan Kassir, et al. Management of complications following bariatric surgery: Summary (International Journal of Surgery, 2014)  https://doi.org/10.1016/j.ijsu.2014.11.009
  20. Alexander J Greenstein, et al. Abdominal Pain Following Gastric Bypass: Suspects and Solutions (Am J Surg, 2012) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123682/
  21. Melinda A. Maggard, et al. Meta-Analysis: Surgical Treatment of Obesity (Annals of Internal Medicine, 2005)http://annals.org/aim/fullarticle/718311/meta-analysis-surgical-treatment-obesity
  22. Roberta Lupoli, et al. Bariatric surgery and long-term nutritional issues (World J Diabetes. 2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700383/
  23. University of California San Francisco, Life after Bariatric Surgery https://www.ucsfhealth.org/education/life_after_bariatric_surgery/
  24. Xu Sun, et al. Ileal interposition reduces blood glucose levels and decreases insulin resistance in a type 2 diabetes mellitus animal model by up-regulating glucagon-like peptide-1 and its receptor (Int J Clin Exp Pathol. 2014) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129028/
  25. Georgios K. Dimitriadis, et al. Potential Hormone Mechanisms of Bariatric Surgery (Curr Obes Rep. 2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585994/
  26. Marianne Gosch C. , et al. ‘Can Type 2 Diabetes Be Corrected Via Bariatric Surgery?’ (Rev Hospital Clinica, Universidad de Chile 2013) https://www.redclinica.cl/Portals/0/Users/014/14/14/Publicaciones/Revista/diabetes_mellitus_tipo_2_se%20corrige_con_cir_bariatrica.pdf
  27. Chelsea R. Hutch, Darleen Sandoval. The role of GLP-1 in the metabolic success bariatric surgery (Endocrinology. 2017) https://www.researchgate.net/publication/320293533_The_role_of_GLP-1_in_the_metabolic_success_bariatric_surgery
  28. Derek M. Culnan, et al. Ileal interposition improves glucose tolerance and insulin sensitivity in the obese Zucker rat (Am J Physiol Gastrointest Liver Physiol. 2010) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950685/
  29. Eng-Hong Pok, Wei-Jei Lee. Gastrointestinal metabolic surgery for the treatment of type 2 diabetes mellitus (World J Gastroenterol. 2014) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202361/
  30. Francesco Rubino, MD, et al. The Mechanism of Diabetes Control After Gastrointestinal Bypass Surgery Reveals a Role of the Proximal Small Intestine in the Pathophysiology of Type 2 Diabetes (Ann Surg. 2006) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856597/
  31. Marcelo M. O. Lima, et al. Acute Effect of Roux-En-Y Gastric Bypass on Whole-Body Insulin Sensitivity: A Study with the Euglycemic-Hyperinsulinemic Clamp (The Journal of Clinical Endocrinology & Metabolism,2010) https://doi.org/10.1210/jc.2010-0085
  32. Philip R Schauer, MD, et al. Effect of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus (Ann Surg. 2003) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360104/
  33. Danuta Rosc, et al.  , CRP, but not TNF-α or IL-6, decreases after weight loss in patients with morbid obesity exposed to intensive weight reduction and balneological treatment*,   (J. Zhejiang Univ Sci B, May, 2015) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432993/
  34. Shereen Aleidi, et al. Adiponectin serum levels correlate with insulin resistance in type 2 diabetic patients (Saudi Pharm J, July 2015)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747076/
  35. Francesco Rubino, MD, et al. The Mechanism of Diabetes Control After Gastrointestinal Bypass Surgery Reveals a Role of the Proximal Small Intestine in the Pathophysiology of Type 2 Diabetes (Ann Surg. 2006) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856597/
  36. Hall TC, , et al. Preoperative factors predicting remission of type 2 diabetes mellitus after roux-en-ygastric bypass surgery for obesity. (Obes Surg, 2010) https://www.ncbi.nlm.nih.gov/pubmed/20524158
  37. SANGEETA R. KASHYAP, et al. Bariatric surgery for type 2 diabetes: Weighing the impact for obese patients (Cleve Clin J Med. 2010) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3102524/
  38. Saadi AlJadir. Bariatric/Metabolic Surgery for Diabesity..! (Endocrinol Metab Int. 2016)  https://medcraveonline.com/EMIJ/EMIJ-03-00043.pdf
  39. Chikunguwo SM, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass (Surg Obes Relat Dis. 2010) https://www.ncbi.nlm.nih.gov/pubmed/20303324
  40. Pete Myall. Type 2 diabetes remission / Surgery is no diabetes cure for most (Bariatric News, 2012) http://www.bariatricnews.net/?q=node/661
Robert Velasquez
28 July, 2019

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Hello everyone, my name is Robert Velazquez. I am a content marketer currently focused on the medical supply industry. I studied Medicine for 5 years. I have interacted with many patients and learned a lot...read more:

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  228. I want to share a message that has been spreading all over the internet that concerns the times we are living in. Whether you believe in God or not, this is a must read message!

    We can see throughout time how we have been slowly conditioned to come to this point where we are on the verge of a cashless society. Would it surprise you to know that the Bible foretold of this event? Don’t believe me? This may be the most imporant message you will read in these times…please do not ignore this!

    This messsage reveals what the Mark of the Beast is, and the meaning behind counting a number people have been pondering for centuries, 666. This message also shares why Barack Obama is the Antichrist. This is truly a message from God!

    In the Revelation of Jesus Christ given to the apostle John, we read:

    “He (the false prophet who deceives many by his miracles) causes all, both small and great, rich and poor, free and slave, to receive a mark on their right hand or on their foreheads, and that no one may buy or sell except one who has the mark or the name of the beast, or the number of his name.

    Here is wisdom. Let him who has understanding calculate the number of the beast, for it is the number of a man: His number is 666” (Revelation 13:16-18 NKJV).

    Referring to the last generation, this could only be speaking of a cashless money society, which we have yet to see, but are heading towards. Why? Revelation 13:17 tells us that we cannot buy or sell unless we receive the mark of the beast in our right-hand or forehead. We could still buy or sell among one another without receiving the mark if physical money was still currency. It logically deduces itself to this reason.

    These verses could not be referring to something spiritual because the word references two different physical locations (our right-hand or forehead) stating the mark will be on one “OR” the other. It once again logically deduces itself to this reason.

    Here is where it really starts to come together. It is shocking how accurate the Bible is concerning the RFID microchip. These are notes from a man named Carl Sanders who worked with a team of engineers to help develop this microchip in the late 1960’s.

    “Carl Sanders sat in seventeen New World Order meetings with heads-of-state officials such as Henry Kissinger and Bob Gates of the C.I.A. to discuss plans on how to bring about a one-world system. The government commissioned Carl Sanders to design a microchip for identifying and controlling the peoples of the world—a microchip that could be inserted under the skin with a hypodermic needle (a quick, convenient method that would be gradually accepted by society).

    Carl Sanders, with a team of engineers behind him, with U.S. grant monies supplied by tax dollars, took on this project and designed a microchip that is powered by a lithium battery, rechargeable through the temperature changes in our skin. Without the knowledge of the Bible (Brother Sanders was not a Christian at the time), these engineers spent one-and-a-half-million dollars doing research on the best and most convenient place to have the microchip inserted.

    Guess what? These researchers found that the forehead and the back of the hand (the two places Revelation says the mark will go) are not just the most convenient places, but are also the only viable places for rapid, consistent temperature changes in the skin to recharge the lithium battery. The microchip is approximately seven millimeters in length, .75 millimeters in diameter, about the size of a grain of rice. It is capable of storing pages upon pages of information about you. All your general history, work history, crime record, health history, and financial data can be stored on this chip.

    Brother Sanders believes that this microchip, which he regretfully helped design, is the “mark” spoken about in Revelation 13:16-18. The original Greek word for “mark” is “charagma,” which means a “scratch or etching.” It is also interesting to note that the number 666 is actually a word in the original Greek. The word is “chi xi stigma,” with the last part, “stigma,” also meaning “to stick or prick.” Carl believes this refers to a hypodermic needle (see photo).

    Mr. Sanders asked a Boston Medical Center doctor what would happen if the lithium contained within the RFID microchip leaked into the body. The doctor responded that if the microchip broke inside a human body, the lithium would cause a severe and painful wound filled with pus. This is what the book of Revelation says:

    “And the first (angel) went, and poured out his vial on the earth; and there fell a noisome and grievous sore on the men which had the mark of the beast, and on them which worshipped his image” (Revelation 16:2).

    THE HIDDEN MEANING BEHIND THE NUMBER 666 REVEALED!

    What I first want to mention, before I share what the Holy Spirit has revealed to me concerning the number of the beast, is that God confirms in threes. We can see this throughout scripture:

    “For there are three that bear witness in heaven: the Father, the Word, and the Holy Spirit; and these three are one” (1 John 5:7 NKJV).

    “and that He was buried, and that He rose again the third day according to the Scriptures” (1 Corinthians 15:4 NKJV).

    “…Holy, holy, holy, Lord God Almighty, Who was and is and is to come!” (Revelation 4:8 NKJV).

    There are many more examples, but I thought I would just share three of them to make the point.

    Examining Revelation 13:16,17,18, the first group of three I would like to point out is that the mark of the beast is described in three separate verses, 16, 17 and 18.

    The next three I see is in verse 16, “He causes all…” is followed by three contrasting categories of people,

    1 – “both small and great,
    2 – rich and poor,
    3 – free and slave…”.

    Then unto verse 17, it opens with, “and that no one may buy or sell except one who has…”, followed by three explanations of what one must have to buy or sell,

    1 – “…the mark
    2 – or the name of the beast,
    3 – or the number of his name”.

    Now unto verse 18, we read “Let him who has understanding calculate…”, which is followed by,

    1 – “the number of the beast,
    2 – for it is the number of a man:
    3 – His number is 666”.

    The last three I see is the number “6” being used three times in a row. The reason I’m making this point about God confirming in three is because it is the key to unlocking how to calculate the number 666.

    Throughout the centuries there have been people trying to calculate numbers based on titles and names that come up to the number 666 to identify one person, the Antichrist; but from Revelation 13:18, I do not see where God is telling us to count up to 666, but rather to count the number of the beast. This number is identified as 666. So the verse is telling us to count the number 666.

    What does it mean to count? It means to add up. So how could we add up 666? Remember my previous point about God confirming in threes is key to unlocking the number 666. So logically, what would be the best way to count the number 666? To count it equally by using the rule of three based off the number.

    We cannot count it equally as 600+60+6, this would also bring us back to the start.

    We cannot count it as 600+600+600, or 60+60+60 because there are no zeroes in between or at the end of 666.

    The only logical option is 6+6+6=18.

    What is interesting is that the verse that reveals for us to count the number itself is verse 18 (there a total of 18 verses in Revelation Chapter 13), being the third verse out of the three verses that describe the mark of the beast in Revelation 13:16,17,18. What is 18 divided by 3? 6. So 3×6=18, or 6+6+6=18.

    Another interesting point is the only two other combinations (making a total of three possible combinations) for placing a “+” symbol in between 666 are:

    66+6=72 and 6+66=72.

    Add both 72’s together and you get 144.

    Why the number 144 is worth our attention is because the verse following Revelation 13:18 is the first time in the Bible where the 144,000 are being described in detail:

    “Then I looked, and behold, a Lamb standing on Mount Zion, and with Him one hundred and forty-four thousand, having His Father’s name written on their foreheads…” (Revelation 14:1).

    Now if you add up all three numbers from counting 666 by moving the “+” symbol around, it would be 72+72+18=162. What is compelling about the number 162, is, if you divide 144,000 by 162, you get 888. The name of Jesus in Greek gematria adds up to 888. The New Testament was originally written in the Greek language. Revelation 14:1 not only mentions the 144,000, but also the Lamb who is Jesus.

    Now what is interesting about the number for Jesus, 888, is that if you apply the same formula that was used to count 666, you get 8+8+8=24. Why the number 24? Revelation chapter 4 tells us there are 24 elders seated around the throne of God. This is the same throne where Jesus sits.

    Now if you take:

    8+8+8=24

    8+88=96

    88+8=96

    you get 24+96+96=216.

    Take 144,000 divided by 216 and you get 666.

    Remember that this was the same exact formula we used to count the number 666 that ultimately brought forth the number 888.

    Here is a quick recap to demonstrate how this formula confirms itself as being the true way to count 666:

    1: 6+6+6=18 > 66+6=72 > 6+66=72 > 18+72+72=162

    2: 144,000 divided by 162=888

    3: 8+8+8=24 > 88+8=96 > 8+88=96 > 24+96+96=216

    4: 144,000 divided by 216=666

    1: 6+6+6=18 > 66+6=72…

    As you can see, it is perpetual. And remember that we consistently used a formula that worked in threes being the number that God uses for confirmation.

    So what could this mean? Well we know in this world we are identified by numbers in various forms. From our birth certificate to social security, as well as our drivers license; being identified based on a system of ruler ship. So it is possible that this RFID microchip will contain a new identification that has a total of 18 characters (6+6+6).

    “here the wisdom is, the one having the mind let him calculate the number of the wild beast, number for “of human” it is, and the number of it 666″ (Revelation 13:1, Greek Translation).

    The Greek word “anthrōpos” being used in verse 18 where it says “of human” is the Greek strongs concordance G444. The first two definitions of the word are “a human being, whether male or female”, and, “generically, to include all human individuals”. Could the number of the beast apply to all mankind?

    In the Greek (the New Testament was originally written in the Greek language), and other translations, you will notice the beast is described as an “it”, instead of “him”. The reason I’m making this point is because when a translation says “His number is 666”, this would imply a singular person, the Antichrist. But by saying “the number of it 666”, implies that it is of the beast system as a whole.

    We can know the number of the beast cannot be to identify products (like a new barcode) to buy or sell because scripture says we cannot buy or sell without the number of the beast. What am I getting at? There will be instances where you could buy something someone made themselves and it wouldn’t have a store branded identification on it. But for this number to be in our chips, that is where it must be to conclude ultimately that we cannot buy or sell without having the number of the beast. As previously mentioned in Revelation 13:18, the number of the beast (6+6+6=18) is a “human number”, definition “generically, to include all human individuals”.

    “Why did the Biden campaign choose 30330? 2020 divided by 666 = 3.0330 Who believes this to be a coincidence? October 2020 Isaiah 53:6 Someone said we are being whipsawed in 2020. Truly a great division is taking place between good and evil—both symbolically and literally (riots, unrest, politics). If you take the current year 2020 and divide it by the number 666 (known for its satanic implications) you will get the number 30330 (repeated). This number 30330 happens to be the number used to vote for Joe Biden and Kamala Harris. Freaky? Supernatural? Odd for sure. Whatever this means, it doesn’t seem good to me. First, why would anyone knowingly choose those particular numbers for their campaign? If they weren’t knowingly chosen, then it appears to be a supernatural act by the evil one himself and I would want to change those numbers ASAP. And if the numbers were chosen knowing their significance, are you satanic? Is this campaign satanic? Either way I do not believe this is a coincidence. And one thing is certain, 2020 is truly being divided by Satan. He is the master deceiver and spreader of chaos. Jesus calls him the father of lies.”

    So I looked up this number 30330 concerning Joe Biden, and I found this information:

    If you send a text to that number (at that time), you would get a response asking to support Joe’s campaign to take down Donald Trump, with one part in caps saying “CHIP IN >>” pointing to a link to go and donate.

    “CHIP IN”? Obama has used this phrase in the past on his twitter and people believe it is a subliminal message to receive the mark of the beast, that is to say the implantable RFID microCHIP that will go IN our body.

    Go to: http://bible-freedom.org to see all the proof!

    Is your name written in the Lamb’s book of life? Jesus says that we must be born again to enter the kingdom of God in the Gospel of John chapter 3.

    “Then a third angel followed them, saying with a loud voice, “If anyone worships the beast and his image, and receives his mark on his forehead or on his hand, he himself shall also drink of the wine of the wrath of God, which is poured out full strength into the cup of His indignation. He shall be tormented with fire and brimstone in the presence of the holy angels and in the presence of the Lamb. And the smoke of their torment ascends forever and ever; and they have no rest day or night, who worship the beast and his image, and whoever receives the mark of his name” (Revelation 14:9-11).

    BARACK OBAMA IS THE ANTICHRIST:

    In the Islamic religion they have man called the Mahdi who is known as their messiah of whom they are waiting to take the stage. There are many testimonies from people online who believe this man will be Barack Obama who is to be the biblical Antichrist based off dreams they have received. I myself have had strange dreams about him like no other person. So much so that I decided to share this information.

    He came on stage claiming to be a Christian with no affiliation to the Muslim faith…

    “In our lives, Michelle and I have been strengthened by our Christian faith. But there have been times where my faith has been questioned — by people who don’t know me — or they’ve said that I adhere to a different religion, as if that were somehow a bad thing,” – Barack Obama

    …but was later revealed by his own family members that he indeed is a devout Muslim.

    So what’s in the name? The meaning of someones name can say a lot about a person. God throughout history has given names to people that have a specific meaning tied to their lives. How about the name Barack Obama? Let us take a look at what may be hiding beneath the surface…

    “And He (Jesus) said to them (His disciples), ‘I saw Satan fall like lightning from heaven'” (Luke 10:18).

    In the Hebrew language we can uncover the meaning behind the name Barack Obama.

    Barack, also transliterated as Baraq, in Hebrew is: lightning

    baraq – Biblical definition:

    From Strongs H1299; lightning; by analogy a gleam; concretely a flashing sword: – bright, glitter (-ing, sword), lightning. (Strongs Hebrew word H1300 baraq baw-rawk’)

    Barak ‘O’bamah, The use of bamah is used to refer to the “heights” of Heaven.

    bamah – Biblical definition:

    From an unused root (meaning to be high); an elevation: – height, high place, wave. (Strongs Hebrew word H1116 bamah baw-maw’)

    The day following the election of Barack Obama (11/04/08), the winning pick 3 lotto numbers in Illinois (Obama’s home state) for 11/5/08 were 666.

    Obama was a U.S. senator for Illinois, and his zip code was 60606.

    These are just a few of many evidences why Barack Obama is the Antichrist. You can see many more in my article on the website above, as well as read about the dreams I’ve had concerning this man. I’m more than convinced that God has shown me that he is without a doubt the Antichrist, and we will see him rise to power in the not so dinstant future.

    Jesus stands alone among the other religions who say to rightly weigh the scales of good and evil, and to make sure you have done more good than bad in this life. Is this how we conduct ourselves justly in a court of law? Bearing the image of God, is this how we project this image into our reality?

    Our good works cannot save us. If we step before a judge, being guilty of a crime, the judge will not judge us by the good that we have done, but rather the crimes we have committed. If we as fallen humanity, created in God’s image, pose this type of justice, how much more a perfect, righteous, and Holy God?

    God has brought down His moral law’s through the 10 commandments given to Moses at Mt. Sinai. These laws were not given so we may be justified, rather that we may see the need for a savior. They are the mirror of God’s character of what He has put in each and every one of us, with our conscious bearing witness that we know that it is wrong to steal, lie, dishonor our parents, and so forth.

    We can try and follow the moral laws of the 10 commandments, but we will never catch up to them to be justified before a Holy God. That same word of the law given to Moses became flesh over 2000 years ago in the body of Jesus Christ. He came to be our justification by fulfilling the law, living a sinless perfect life that only God could fulfill; even bringing the law to it’s truest light by stating, “You have heard that it was said to those of old, ‘You shall not commit adultery.’ But I say to you that whoever looks at a woman to lust for her has already committed adultery with her in his heart” (Matthew 5:27-28).

    The gap between us and the law can never be reconciled by our own merit, but the arm of Jesus is stretched out by the grace and mercy of God. And if we are to grab on, through faith in Him, He will pull us up being the one to justify us. As in the court of law, if someone steps in and pays our fine, even though we are guilty, the judge can do what is legal and just and let us go free. That is what Jesus did almost 2000 years ago on the cross. It was a legal transaction being fulfilled in the spiritual realm by the shedding of His blood.

    Because God is Holy and just, the wrath that we deserve could not go unnoticed. Through the perfect righteousness and justice of God’s character, it must be dealt with, it must be quenched, it must be satisfied.

    For God takes no pleasure in the death of the wicked (Ezekiel 18:23). This is why in Isaiah chapter 53, where it speaks of the coming Messiah and His soul being a sacrifice for our sins, why it says it pleased God to crush His only begotten Son.

    This is because the wrath that we deserve was justified by being poured out upon His Son. If that wrath was poured out on us, we would all die and go to hell. God created a way of escape by pouring it out on His Son whose soul could not be left in Hades, but was raised to life on the third day and seated at the right hand of God in power.

    So now when we put on the Lord Jesus Christ (Romans 13:14), God no longer sees the person who deserves His wrath, but rather the glorious image of His perfect Son dwelling in us, justifying us as if we received the wrath we deserve, making a way of escape from the curse of death.

    Now what we must do is repent and put our trust and faith in the savior, confessing and forsaking our sins. This is not just a head knowledge of believing in Jesus, but rather receiving His words, taking them to heart, so that we may truly be transformed into the image of God. Where we no longer live to practice sin, but rather turn from our sins and practice righteousness through faith in Him.

    Jesus answered, “Most assuredly, I say to you, unless one is born of water and the Spirit, he cannot enter the kingdom of God. That which is born of the flesh is flesh, and that which is born of the Spirit is spirit. Do not marvel that I said to you, ‘You must be born again'” (John 3:5-7).

    Come before the Lord with a contrite spirit, humble yourself, ask Him for His forgiveness, to receive the free gift of His salvation, to receive His Holy Spirit, so that you may be transformed into a new creature, into a child of the living God.

    There is a reason why the words of Jesus have been translated in to over 2000 languages, and nothing comes remotely close (the Quran just over 100), because there is a God in heaven who desires to have a relationship with you, to know Him through His word, as that is how we personally get to know anybody. There is a reason why it is the year 2021, because Jesus came to earth just over 2000 years ago fulfilling major prophecy causing a divide in our timeline.

    Jesus loves you! Seek Him while He may be found! We must repent and turn from practicing sin…for if we are not following Jesus, we are following the devil. There is no neatural ground. We are either living in the lie, or the truth. God bless you!

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